H₂-Receptor Antagonists in the Treatment of Reflux Oesophagitis

Abstract

H₂-receptor antagonists are useful for relief of symptoms and in the healing of reflux oesophagitis. The therapeutic response is related to the initial degree of severity of oesophagitis, and standard doses of H₂-receptor antagonists are only reliably effective in the treatment of mild disease. Pharmacodynamic studies indicate that in patients with more severe grades of oesophagitis standard doses of H₂-receptor antagonists may be less effective at inhibiting gastric secretion and reducing total reflux time. This is associated with a suboptimal response to therapy. In non-responders to standard dose therapy, 24-h intra-oesophageal pH profiles can be normalized by increasing the dose of H₂-receptor antagonist. A high-dose ranitidine regimen (300 mg four times daily) markedly improves healing of oesophagitis and symptom relief compared with standard therapy. Reflux oesophagitis relapses rapidly after cessation of medical therapy. It appears that continuous treatment with doses similar to those required to achieve healing are necessary to prevent relapse. Long-term high-dose maintenance therapy seems to be of value in patients with stricture formation and may lead to regression of gastric epithelium in patients with Barrett's oesophagus.

Key Words:

• Gastro-oesophageal reflux
• H₂-receptor antagonists
• oesophageal pH
• reflux oesophagitis